ATI chapter 33 diabetes mellitus pediatrics

Characterized by partial or complete metabolic deficiency of insulin
Diabetes mellitus
Diabetes mellitus is a contributing factor for the development of what
Cardiovascular disease
hypertension
renal failure
blindness and stroke
Toxins and viruses can predispose an individual 2 diabetes by destroying the beta cells which type of diabetes
Type 1
Obesity, physical inactivity, high triglycerides, and hypertension may lead to the development of insulin resistance diabetes what type
Type 2
Blood glucose level is less than 60
Hypoglycemia
Autonomic nervous system responses rapid onset
Hunger, lightheadedness, and shakiness headache anxiety and irritability
pale, cool skin
diaphoresis irritability
normal or shallow respirations
tachycardia and palpitations
Impaired cerebral function gradual onset
Strange or unusual feelings
decreasing level of consciousness
difficulty in thinking and inability to concentrate
change an emotional behavior
slurred speech
headache and blurred vision
seizures leading to coma
Blood glucose levels usually greater than 250
Hyperglycemia
Assessment findings of hyperglycemia
thirst
polyuria oliguria
nausea vomiting
abdominal pain
skin that is warm dry and flushed with poor tugor
mucous membranes
confusion
weakness with lethargy
weak pulse
diminish reflexes
rapid deep respirations with acetone fruity odor due to ketones
Diagnostic criteria for diabetes
An 8 hour fasting blood glucose level of 126 or more a random blood glucose of 200 or more with classic signs of diabetes and oral glucose tolerance test of 200 or more in a two hour sample
What is the expected reference range for glycosylated hemoglobin
4% to 6% but an acceptable target for children who have diabetes may be 6.5% to 8% with a total target goal of less than 7%
Signs and symptoms of hypoglycemia
Shakiness
diaphoresis
anxiety
nervousness
chills
headache
confusion
labile
difficulty focusing
hunger
dizziness
heart palpitations
Rapid acting insulin
Insulin lispro Humalog
Onset of Humalog
Less than 15
peak of Humalog
0.5 to 1 hour
Duration of Humalog
Three to four hours
Short acting insulin
Regular insulin Humulin R
Onset of short acting insulin
0.5 to 1 hr
Peak of short acting insulin
2 – 4 hours
Duration of short acting insulin
5 – 7 hours
Intermediate acting insulin
NPH insulin Humulin N
Onset of intermediate acting insulin
1 – 2 hour
Peak of intermediate acting insulin
4 – 12 hours
Duration of intermediate acting insulin
18 – 24 hours
Long acting insulin
Insulin glargine lantus
Onset of long acting insulin
Three to four hours
Peak of long acting insulin
There is none
Duration of long acting insulin
10.4 – 24 hours
Nursing considerations in education on insulin
Do not mix insulin glargine with any other insulins
Inject at a 90 degree angle
when mixing rapid and short draw up short acting insulin first
Acute life-threatening condition characterized by hyperglycemia resulting in the breakdown of body fat for energy and accumulation of ketones in the blood and urine the onset is rapid and mortality rate is high
Diabetic ketoacidosis
Causes of diabetic ketoacidosis
Insufficient insulin acute stress poor management of acute illness
Nursing actions for diabetic ketoacidosis
provide rapid isotonic fluid is 0.9% sodium chloride follow with a hypotonic fluid 0.5% sodium chloride excessive subjective and objective data
ketones in blood and urine
fruity scented breath
mental confusion
dyspnea nausea and vomiting
dehydration
weight loss
electrolyte imbalances
if left untreated patient can go into a coma
when glucose levels approach 250 a glucose IV fluids to minimize the risk of cerebral edema
monitor glucose
monitor serum potassium levels
administer sodium bicarbonate administer oxygen
Long-term complications with diabetes mellitus
Neuropathy
retinopathy
nephropathy
cardiovascular disease
altered thyroid function
limited mobility of small joints
a nurse is reviewing sick day management with a parent of a child who has type 1 diabetes. Which of the following should the nurse include in the teaching? Select all that apply
a. Monitor blood glucose levels every 3 hours
b. discontinue taking insulin feeling better
c. drink 8 oz of fruit juice every hour
d. test urine for ketones
e. call the health care provider if blood glucose is greater than 240
Monitor blood glucose levels every 3 hours test urine for ketones call the health and care provider in blood glucose is greater than 240
a nurse is teaching a child with type 1 diabetes mellitus about self care. Which of the following statements by the child indicates understanding of the teaching?
a. i should skip breakfast when i am not hungry
B. i should increase my insulin with exercise
C. I should drink a glass of milk when I’m feeling irritable
D. i should draw up the NPH insulin into the syringe before regular insulin
I should drink a glass of milk when I’m feeling irritable
a nurse is caring for a child with type 1 diabetes. Which of the following is a clinical manifestation of diabetic ketoacidosis? Select all that apply
A. blood glucose 58
B. weight gain
c. Dehydration
D. mental confusion
E. fruity breath
Dehydration mental confusion fruity breath
A nurse is teaching an adolescent who has diabetes about foot care. Which of the following should be included and the teaching?
A. inspect feet once a week
B. cut your toe nail in rounded formatoin
C. You can use cornstarch on your feet
D. you can use over the counter callus removers
You can use cornstarch on your feet
A nurse is teaching an adolescent with diabetes about clinical manifestations of hypoglycemia. Which of the following should be included in teaching? Select all that apply
A. increased urination
B. hunger
C. signs of dehydration
D. irritability
E. sweating and pallor
F. kussmaul respirations
Hunger irritability sweating and pallor